Aristide Economopoulos/The Star-LedgerU.S. House Speaker Nancy Pelosi walks with gavel in hand to the Capitol with the Democratic caucus including New Jersey U.S. Rep. Steven Rothman (D-9), right.WASHINGTON, D.C. -- President Barack Obama could sign the national health care reform bill as early as Tuesday, but the opportunity for New Jersey’s 1.3 million uninsured people to shop for bargains or seek financial aid to buy a policy is still four years away.

Federal lawmakers built in the delay to phase-in the creation of the new National Health Insurance Exchange, where consumers and employers will buy their coverage and apply for subsidies if they meet income guidelines, New Jersey hospital executives, physicians and health advocates said today.

“This is a major change in the health care system, and like an ocean liner, in order to make a change, it takes a long time to see the boat move after you turn the wheel," David Shulkin, chief operating officer and President-elect of Morristown Memorial Hospital.

Even some of the more immediate benefits of the 2,500-page bill won’t make a big splash in the Garden State because they already exist. New Jersey already allows adult children to remain on their parents’ health plan until they turn 31 — five years longer than the federal legislation will allow.

Still, many health and consumer representatives praised the landmark legislation for its goals of controlling runaway costs and enabling people to gain access to preventative and routine medical care.

“This ... historic vote offers tremendous promise for New Jersey’s health care consumers, our physicians and hospitals and most importantly for New Jersey’s 1.3 million residents without health insurance," said Betsy Ryan, president and CEO of the New Jersey Hospital Association. People who have never had health insurance “will have an insurance card, and see a primary care doctor when it’s needed instead of waiting until they are really sick to see a doctor," she said.

The law would also do away with lifetime caps on insurance coverage, and force insurance companies to cover people right away with pre-existing medical conditions.

“The biggest impact in my view is job freedom for those that are locked into unfulfilling jobs where they cannot reach their full potential because someone in their family has a chronic illness that traps them from leaving because of pre-existing conditions,’’ said Richard Goldstein, president of the New Jersey Council on Teaching Hospitals. “I predict tens of thousands of working people will seek new jobs or start their own businesses.’’

JoAnn Brendel, a Saddle Brook woman who has survived uterine and colon cancer, said the reforms will protect her from maxing out her insurance coverage, which is currently $1 million.

“It’s a relief for me,’’ she said. “If I don’t have a cap on my policy I don’t have to worry about not having coverage.”

Costly co-payments for treatments forced her to move back in with her parents, even though she has insurance, and to incur credit-card debt, she said. “People who have cancer are financially destroyed. You have no life savings, nothing,” she said.

People will have an alternative to paying the exorbitant premiums and copays charged under the state’s Small Employer Health Plan and the Individual Health Coverage Program, said Eve Weissman, health care campaign coordinator for the consumer rights group, Citizen Action.

There are 793,000 people and 112,000 people enrolled in the plans, respectively, Banking and Insurance Commissioner Ed Rogan said.

“For those people who have coverage, they may not see any immediate changes. They will have that coverage and hopefully the cost will go down, and employers may be able to improve what they offer at a lower cost," Weissman said.

Lindy Washburn and Mary Jo Layton of The Record contributed to this report.